Attenuation of severe ketamine-induced neuropsychiatric side effects by lamotrigine in a patient with treatment resistant bipolar depression: A case report

Though usually mild, neuropsychiatric side effects of intravenous ketamine for depression occasionally result in treatment discontinuation. Two small clinical trials of healthy subjects have indicated that lamotrigine pre-treatment may attenuate these side effects, though two other trials, one in patients with unipolar depression and one in healthy male volunteers, did not support these findings. While case reports and observational studies have documented successful treatment of patients with bipolar depression receiving lamotrigine and ketamine, none have reported on cessation of neuropsychiatric side effects from ketamine after lamotrigine initiation in this patient population. Here we present the case of a patient with treatment resistant bipolar depression successfully pre-treated with lamotrigine to prevent previously experienced severe neuropsychiatric side effects from ketamine. She tolerated the ketamine infusion well and her depressed mood improved rapidly. This case suggests that concurrent treatment with lamotrigine may present an effective tolerability improvement strategy for patients with bipolar depression who have previously experienced neuropsychiatric side effects from ketamine.